If you're a gay man who has had sex just once in the last year, then the NHS does not, under any circumstances, want your blood.
It's easy to frame this ban as a bigoted, hypocritical anachronism and one of the final legislative hurdles to total equality. I'm gay myself and getting angry about it feels like the obvious response, a knee-jerk reaction against a total injustice. It's a sentiment I shared with others in the gay community.
The double standards are palpable, the insinuations perverse: if a married and monogamous gay guy has sex with his partner just once in the last year he's deemed high risk and can't donate, but it's fine – ostensibly – for the promiscuous straight guy with a new partner every day to do so. With the NHS constantly urging more donors to come forward, it sends out a loaded message: we desperately need more blood, just not if it's gay.
But – and it's a big but – it's very easy to forget that this isn't a social issue. It's a medical one. Donating blood isn't a civil right.
The reality is that certain groups – men who have sex with men (MSM), people who inject drugs, those from regions with high HIV prevalence like Sub-Saharan Africa – are statistically more likely to have HIV or other blood-borne viruses like Hepatitis B and C. Even with current testing technology, HIV can remain undetectable in the blood stream for up to four weeks from transmission. For Hepatitis B that period can be up to a year.
When determining who can and can't donate, keeping the blood supply safe from infection has to be the main priority. "I think it's a bit distracting to think of it as an equality issue," says Dr Michael Brady, a sexual health and HIV consultant at Kings College Hospital and a medical director of the Terrence Higgins Trust. "It's not an equality or homophobic thing – it's a safety of public health thing.
"We know that there are certain groups... where these infections [HIV and Hepatitis B and C] are more common. If you were only worried about HIV, then the tests we use nowadays are good enough to pick it up within four weeks of catching it," Brady continues. "So you could be confident about having a much shorter deferral period. But you'd probably want to make it three months to be 100 percent sure. Hepatitis B and Hepatitis C have much longer periods before showing up in the blood."
If the deferral period was to be lifted entirely, then the screening for high-risk donors would have to be done through self-assessment. Everyone would fill out a probing questionnaire to notify the NHS of the last time they'd had bareback anal sex, and doctors would remove those who pose a higher risk from the donor pool. On paper, at least, it's the "fairest" way.
"In an ideal world that would be great," says Brady, of this so-called "fair" system. "The problem with it is – and this comes from working for nearly 20 years in a sexual health clinic – that people are not really that good at assessing or confessing their own risk."
The clamour of the 80s and 90s' "AIDS epidemic" has died down, and people no longer think that the disease poses them a great a risk. This is, says Brady, "one of the reasons that we still see increasing rates of HIV." Why? "Because people underestimate what their risk of HIV is or they underestimate the risk of the person they're having sex with. At least 20 to 25 percent of people that have got it don't know they have it, because they don't perceive themselves to be at risk and they don't go and get a test. "
Transmission of HIV among gay men is increasing, and a third of those are diagnosed late – meaning they've been living with the virus, unaware and without treatment, for over four years. So, gay men calling for the deferral period to be lifted entirely could actually be doing their community more harm than good. A total repeal is as good as saying HIV is no longer an issue for gay men. But the statistics say otherwise – 1 in 20 gay men in the UK have HIV (the national average is 1 in 360). The mentality that gay men don't need to worry anymore will only breed complacency.
"HIV transmission rates among MSM are much much higher than among the general population," says Yusef Azad, director of policy and campaigns at the National AIDS Trust. "And the fact is that, while the blood supply is screened, if you got HIV recently there is a risk that it will not be picked up. As a gay man myself, I don't think we're doing ourselves any favours by somehow claiming – or pretending – that there is no difference in risk between gay and straight men."
Azad also says that total removal of the ban could even be harmful to the gay community. "The idea that absolutely no system of deferral or different treatment is needed does gay men a disservice," he explains. "It pretends, in effect, that everyone is equally at risk of HIV, which is not true. It is a refusal to face the fact of the very high HIV rates among gay men."
The current deferral period for 12 months (as opposed to something much shorter) is a result of the time it can take to detect hepatitis B. NAT believes there is enough evidence to look again at whether rates of hepatitis B amongst MSM require such a long deferral. NAT have formally requested the Government's Advisory Committee on the Safety of Blood, Tissues and Organs ( SaBTO) to review whether the current 12 month deferral period on MSM blood donors is still justified. When they eventually do so, SaBTO's decision will not be based on rhetoric and notions of fairness but medical evidence and probability.
"Every blood service has to balance the need to be cautious and protect the integrity of the blood supply from infection," says Azad. "We need to be hard-nosed about this. It's about protecting the blood supply for everyone, including the LGBT community. LGBT people received blood transfusions just like anyone else, and both expect and need them to be safe."
I understand the anger over a ban on gay men being able to do something altruistic like give blood. Ultimately, though, we can't ignore the statistics. We can't pretend there's no difference in risk and it feels like there are far bigger, more urgent LGBT inequality issues out there that are directly affecting our community on a day-to-day level. Things like disproportionate levels of poverty, homelessness, unemployment and inadequate mental health services. That's where real equality activism is needed.
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